Forms

Welcome to Providence Family Medicine Northeast. We look forward to your visit!

New Patient Forms

Please print this document and fill it out completely. Then bring it with you to your first appointment.

Special Forms

You do not need to complete these forms unless our office gives you special instructions to do so.

Please complete the following steps for your first visit:

  1. Send us your previous medical records, lab results, or immunization records.
  2. Arrive 30 minutes early.
  3. Bring your completed New Patient Forms (linked above)
  4. Bring your regular over-the-counter and prescription medications.
  5. Bring your insurance card(s)
  6. Bring a photo ID (Federal Regulations require this)

All patients are responsible for co-pays, deductibles, co-insurance and charges for services rendered at the time of the appointment. Patients without insurance cards are considered Self Pay. We accept cash,check and credit cards.

If you are more than 15 minutes late to your appointment, you may be asked to reschedule.

Contact us with any questions or concerns. Thank you for your cooperation.